Vitamin D Update

Vitamin D and Covid-19

Press release from the French National Academy of Medicine 22 May 2020

http://www.academie-medecine.fr/wp-content/uploads/2020/05/20.5.22-Vitamine-D-et-coronavirus-ENG.pdf

Vitamin D is a prohormone

Synthesized in the dermis under the effect of ultraviolet light

Transported to the liver and kidneys, where it is transformed into an active hormone

Responsible for intestinal absorption of calcium and bone health.

Modulates the functioning of the immune system by stimulating macrophages and dendritic cells

Role in regulating and suppressing the cytokine inflammatory response

Acute respiratory distress syndrome

A significant correlation between low serum vitamin D levels and mortality from Covid- 19

This phenomenon follows a North-South gradient

Exceptions are Nordic countries, vitamin D supplementation

Not a preventive or a therapeutic

By mitigating the inflammatory storm and its consequences, considered as an adjunct to any form of therapy.

Simple and inexpensive measure

Confirms its recommendation to ensure vitamin D supplementation in the French population

Recommends the rapid serum vitamin D (i.e. 25 OHD) testing in people over 60 years of age with Covid-19

Loading dose of 50,000 to 100,000 IU in case of deficiency, which could help limit respiratory complications;

Recommends vitamin D supplementation of 800 to 1000 IU/day in people under 60, as soon as the diagnosis of Covid-19 is confirmed.
Vitamin D: A Low-Hanging Fruit in COVID-19? (Medscape)

https://www.medscape.com/viewarticle/930660?src=wnl_tp10n_200605_mscpedit&uac=127834AR&impID=2406378&faf=1

Observational data from various countries suggest inverse links;

Severity of COVID-19 responses
Mortality

No randomized controlled trial

Having adequate vitamin D is important, especially for those at the highest risk of COVID-19

No role
Simply a marker
A causal factor

Spain and northern Italy, high rates of vitamin D deficiency

Spain and Italy not formally fortify foods or recommend supplementation

Norway, Finland, and Sweden had higher vitamin D levels

European countries, P = .046, 95.4% confidence, (4.6% chance this result arose by chance)

Correlation is not causality

Optimizing vitamin D status to recommendations by national and international public health agencies will certainly have, potential benefits for COVID-19 (Irish Medical Journal), http://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/

Immune Modulation
https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4

Data from China, France, Germany, Italy, Iran, South Korea, Spain, Switzerland, United Kingdom, United States

Risk of severe COVID-19

Vitamin D deficiency was 17.3%

Normal Vitamin D level was 14.6%
(a reduction of 15.6%).

Ethnic Minorities Disproportionately Affected

British Association of Physicians of Indian Origin (BAPIO) to get their vitamin D levels tested.

LARGE, SINGLE-DOSE, ORAL VITAMIN D SUPPLEMENTATION IN ADULT POPULATIONS: A SYSTEMATIC REVIEW
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4128480/

They suggest a booster dose of 100,000 IU as a one-off

Single vitamin D3 doses ≥300,000 IU are most effective at improving vitamin D status…for up to 3 months

Daily doses of 1000 IU seem reasonable

Testing and Governmental Recommendations During COVID-19

US National Institute of Health
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

400 IU to 800 IU per day, will result in blood levels that are sufficient to maintain bone health and normal calcium metabolism in healthy people

Public Health England (PHE)
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/

There is not sufficient evidence to support recommending Vitamin D for reducing the risk of COVID-19 (PHE)

https://derbynews.org.uk/2020/06/09/covid-19-a-daily-dose-of-vitamin-d-could-significantly-reduce-the-death-rate-in-black-asian-people/?fbclid=IwAR1T8KvXIQBOcgpUgL99SUy2fA3LaTu-fBoO13vOs1lEcqrXfnHY2aub4GU

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